A 27-year-old fouth gravida patient with previous two partial molar pregnancies and one missed ab... more A 27-year-old fouth gravida patient with previous two partial molar pregnancies and one missed abortion underwent a suction evacuation for partial molar pregnancy at 9 weeks of gestation. She was followed up with serum HCG values. Though the HCG level reduced from a pre-evacuation value of 1 40 223-31 157 mIU/ml 1 week post procedure, the levels continued to be positive in low titres 6 months after suction evacuation. The management options were discussed with the patient and a decision was taken to continue surveillance with serial HCG titres. HCG levels normalised after 11 months without the need for chemotherapy.
A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live f... more A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live fetus (parameters approximately 23 weeks) and a huge placenta with multiple cystic areas extending into the lower uterine segment; some of which showed increased vascularity on colored doppler. A diagnosis of low lying placenta with a possibility of chorangioma or a partial mole was made. The next bout of antepartum hemorrhage was severe necessitating an emergency cesarean. Histopathology of the placenta (weighing 2240 grams) revealed a myxoid chorangioma. All features in this woman are uncommonly reported in literature (large size, myxoid degeneration and severe antepartum hemorrhage necessitating a cesarean).
Finger and Palmar dermatoglyphics in 25 karyotypically proven cases of Turner syndrome representi... more Finger and Palmar dermatoglyphics in 25 karyotypically proven cases of Turner syndrome representing Northwestern region of India are presented and compared with those obtained on their 102 normal female counterparts. Predominance of ulnar loops over other patterns was recorded in turner patients. Mean total finger ridge count in Turner syndrome (147.4) remained higher than the normal females (121.1). c-d interdigital
Results: The incidence of peripartum hysterectomy was 6.86 per 1000 deliveries during the period ... more Results: The incidence of peripartum hysterectomy was 6.86 per 1000 deliveries during the period of evaluation. Of these, only 2 women were hospital supervised whereas the majority of patients were referrals. The main indications of peripartum hysterectomies were placenta accreta (60%), atonic PPH (27.5%) and uterine rupture (7.5%). Intensive care management was deemed necessary in 35% of women postoperatively. A high incidence of maternal morbidity was observed by discharge. Most common maternal complications were febrile morbidity, bladder injury, disseminated intravascular coagulation and wound infection. There were four maternal deaths (10%) following peripartum hysterectomy done for atonic PPH.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2015
Gonz á lez CH , Vargas FR , Á lvarez-P é rez AB , Kim CA , Brunoni D , MarquesDias MJ et al . 199... more Gonz á lez CH , Vargas FR , Á lvarez-P é rez AB , Kim CA , Brunoni D , MarquesDias MJ et al . 1993 . Limb defi ciency with or without M ö bius sequence in seven Brazilian children associated with misoprostol use in the fi rst trimester of pregnancy . American Journal of Medical Genetics 47 : 59 – 64 . Orioli IM , Castilla EE . 2000 . Epidemiological assessment of misoprostol teratogenicity . British Journal of Obstetrics and Gynaecology 107 : 519 – 523 . Sch ü ler L , Pastuszak A , Sanseverino MT , Orioli IM , Brunoni D , Koren G . 1997 . Pregnancy outcome aft er abortion attempt with misoprostol . Teratology 55 : 36 .
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 10, 2014
A total of 200 women planned for labour induction were randomised to receive high-dose oxytocin (... more A total of 200 women planned for labour induction were randomised to receive high-dose oxytocin (6 mU/min with similar increments every 45 min) or intermediate-dose oxytocin (3 mU/min with similar increments every 45 min). Oxytocin solution was prepared with 30 units in 500 ml saline with which the infusion rate in ml/h is numerically equal to oxytocin in mU/min. We observed that the caesarean rate (18% vs 6%, p = 0.009), contraction abnormalities (35% vs 14%, p = 0.0005) and neonatal bilirubin levels (7.99 ± 2.70 vs 6.80 ± 2.65, p = 0.002) were higher with high-dose than with intermediate-dose. The induction-delivery interval (IDI) was similar (10 h 13 min with high-dose and 11 h 5 min with intermediate-dose; p = 0.237, NS). Nulliparous women benefited more with intermediate-dose as the caesarean rate was higher with high-dose (24.6% vs 7.9%, p = 0.011). Although the caesarean rate was higher in multiparous women with high-dose oxytocin, it was statistically not significant (5.7% v...
International journal of obstetric anesthesia, 2010
Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves ... more Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. We therefore studied the effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing caesarean section were included in a prospective, double blind, placebo-controlled trial. Patients were randomly assigned to receive spinal anaesthesia with 2 mL 0.5% hyperbaric bupivacaine and 25 microg fentanyl with either 0.1 mL of 0.9% sodium chloride (control group) or 0.1 mL of 50% magnesium sulphate (50 mg) (magnesium group). Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesia re...
Though a number of barrier methods and potent spermicides are available, most of these have nonox... more Though a number of barrier methods and potent spermicides are available, most of these have nonoxynol-9 (N-9) as the active ingredient which is observed to cause inflammation and genital ulceration on repeated use. The present study was undertaken to develop a safe spermicide with conjoint microbicidal properties. A polyherbal pessary was formulated with purified ingredients from neem (Azadirachta indica) leaves, Sapindus mukerossi (pericarp of fruit) and Mentha citrata oil. Spermicidal action on human sperm was tested by Sander-Cramer slide test in vitro and by post coital tests in vivo. Contraceptive action was tested in rabbits. The combination of the three herbal ingredients resulted in the potentiation of the spermicidal action by 8-folds. The post coital tests confirmed the spermicidal properties of the Praneem polyherbal pessary (PPP) in women with high cervical mucous score around mid estrus. It also prevented in most women the migration of sperm into the cervical mucous. In...
The present study evaluates the role of prophylactic intrapartum antibiotics in the prevention of... more The present study evaluates the role of prophylactic intrapartum antibiotics in the prevention of neonatal sepsis. Labour and delivery characteristics of 1478 women delivering at the Nehru Hospital, PGIMER, Chandigarh were recorded. Intrapartum antibiotics (ampicillin, with or without gentamycin) were given to 69 per cent women. The neonatal sepsis rate was 1.56 per cent. This was not significantly lower in the women who received intrapartum antibiotics (1.47 vs 1.75%). Though there was a lowering of neonatal sepsis rate with intrapartum antibiotic administration when the duration of labour was more than 12 h (1.67 vs 3.09%), duration of ruptured membranes was more than 6 h (1.93 vs 3.81%) and number of pelvic examination was 3 or more (1.63 vs 4.54%), it was not statistically significant. It was concluded that intrapartum antibiotics as per the existing protocol did not prevent neonatal sepsis.
Birth weight charts of uncomplicated singleton pregnancies (n=3293) were prepared from subjects w... more Birth weight charts of uncomplicated singleton pregnancies (n=3293) were prepared from subjects who delivered between 30 and 42 weeks of gestation. Multiple regression analysis of the data revealed significant effect of maternal age, parity, height, weight and religion upon birth weight. Maternal blood pressure systolic ≥160 mm of Hg and diastolic ≥110 mm of Hg (severe PIH) were associated with
methods that are less dependent on patient positioning, which is one potential limitation of ster... more methods that are less dependent on patient positioning, which is one potential limitation of sternomental distance measurement. For instance, it has been shown that sternomental distance may change depending on when the measurement is taken; that is, before (sitting, conscious) or after (supine, unconscious) induction of general anesthesia [6]. Regardless of the assessment method used, predicting a difficult airway is highly subjective. Indeed, various factors, including patient anatomy and co-morbidities, technical skill and experience of the assessor, and medications administered (e.g. neuromuscular blocking drugs), influence the degree to which a difficult airway can be predicted with accuracy. In any case, these methods are merely used to prepare oneself for the possibility of a difficult airway – the true test comes at the time of intubation. As has been stated before with respect to physical examination methods, no screening test is 100% sensitive and 100% specific [5]. Similarly, we anticipate that ultrasonography will not predict difficult intubation all the time. Thus, I believe that ultrasound and physical methods should be used in combination to obtain the best idea of how difficult intubation will be for a given case.
Cancer imaging : the official publication of the International Cancer Imaging Society, Jan 18, 2011
Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable m... more Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable malignant potential known to occur anywhere in the body. IMFT involving the omentum is a very rare entity with less than 15 cases reported so far. We report a case of omental IMFT in a 15-year-old girl who presented with multiple peritoneal masses on imaging and the diagnosis was confirmed on histopathology. In addition to its uncommon location, its presentation as multiple masses is extremely uncommon. This uncommon presentation as multifocal masses needs to be distinguished from other causes of peritoneal carcinomatosis.
Hydatidiform mole (HM) is a human pregnancy with excessive trophoblastic proliferation and abnorm... more Hydatidiform mole (HM) is a human pregnancy with excessive trophoblastic proliferation and abnormal embryonic development that may be sporadic or recurrent. In the sporadic form, the HM phenotype is driven by an abnormal ratio of paternal to maternal genomes, whereas in the recurrent form, the HM phenotype is caused by maternal-recessive mutations, mostly in NLRP7, despite the diploid biparental origin of the HM tissues. In this study, we characterised the expression of the imprinted, maternally expressed gene, CDKN1C (p57(KIP2)), the genotype, and the histopathology of 36 products of conception (POC) from patients with two defective alleles in NLRP7 and looked for potential correlations between the nature of the mutations in the patients and the various HM features. We found that all the 36 POCs are diploid biparental and have the same parental contribution to their genomes. However, some of them expressed variable levels of p57(KIP2) and this expression was strongly associated wit...
A 27-year-old fouth gravida patient with previous two partial molar pregnancies and one missed ab... more A 27-year-old fouth gravida patient with previous two partial molar pregnancies and one missed abortion underwent a suction evacuation for partial molar pregnancy at 9 weeks of gestation. She was followed up with serum HCG values. Though the HCG level reduced from a pre-evacuation value of 1 40 223-31 157 mIU/ml 1 week post procedure, the levels continued to be positive in low titres 6 months after suction evacuation. The management options were discussed with the patient and a decision was taken to continue surveillance with serial HCG titres. HCG levels normalised after 11 months without the need for chemotherapy.
A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live f... more A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live fetus (parameters approximately 23 weeks) and a huge placenta with multiple cystic areas extending into the lower uterine segment; some of which showed increased vascularity on colored doppler. A diagnosis of low lying placenta with a possibility of chorangioma or a partial mole was made. The next bout of antepartum hemorrhage was severe necessitating an emergency cesarean. Histopathology of the placenta (weighing 2240 grams) revealed a myxoid chorangioma. All features in this woman are uncommonly reported in literature (large size, myxoid degeneration and severe antepartum hemorrhage necessitating a cesarean).
Finger and Palmar dermatoglyphics in 25 karyotypically proven cases of Turner syndrome representi... more Finger and Palmar dermatoglyphics in 25 karyotypically proven cases of Turner syndrome representing Northwestern region of India are presented and compared with those obtained on their 102 normal female counterparts. Predominance of ulnar loops over other patterns was recorded in turner patients. Mean total finger ridge count in Turner syndrome (147.4) remained higher than the normal females (121.1). c-d interdigital
Results: The incidence of peripartum hysterectomy was 6.86 per 1000 deliveries during the period ... more Results: The incidence of peripartum hysterectomy was 6.86 per 1000 deliveries during the period of evaluation. Of these, only 2 women were hospital supervised whereas the majority of patients were referrals. The main indications of peripartum hysterectomies were placenta accreta (60%), atonic PPH (27.5%) and uterine rupture (7.5%). Intensive care management was deemed necessary in 35% of women postoperatively. A high incidence of maternal morbidity was observed by discharge. Most common maternal complications were febrile morbidity, bladder injury, disseminated intravascular coagulation and wound infection. There were four maternal deaths (10%) following peripartum hysterectomy done for atonic PPH.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2015
Gonz á lez CH , Vargas FR , Á lvarez-P é rez AB , Kim CA , Brunoni D , MarquesDias MJ et al . 199... more Gonz á lez CH , Vargas FR , Á lvarez-P é rez AB , Kim CA , Brunoni D , MarquesDias MJ et al . 1993 . Limb defi ciency with or without M ö bius sequence in seven Brazilian children associated with misoprostol use in the fi rst trimester of pregnancy . American Journal of Medical Genetics 47 : 59 – 64 . Orioli IM , Castilla EE . 2000 . Epidemiological assessment of misoprostol teratogenicity . British Journal of Obstetrics and Gynaecology 107 : 519 – 523 . Sch ü ler L , Pastuszak A , Sanseverino MT , Orioli IM , Brunoni D , Koren G . 1997 . Pregnancy outcome aft er abortion attempt with misoprostol . Teratology 55 : 36 .
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 10, 2014
A total of 200 women planned for labour induction were randomised to receive high-dose oxytocin (... more A total of 200 women planned for labour induction were randomised to receive high-dose oxytocin (6 mU/min with similar increments every 45 min) or intermediate-dose oxytocin (3 mU/min with similar increments every 45 min). Oxytocin solution was prepared with 30 units in 500 ml saline with which the infusion rate in ml/h is numerically equal to oxytocin in mU/min. We observed that the caesarean rate (18% vs 6%, p = 0.009), contraction abnormalities (35% vs 14%, p = 0.0005) and neonatal bilirubin levels (7.99 ± 2.70 vs 6.80 ± 2.65, p = 0.002) were higher with high-dose than with intermediate-dose. The induction-delivery interval (IDI) was similar (10 h 13 min with high-dose and 11 h 5 min with intermediate-dose; p = 0.237, NS). Nulliparous women benefited more with intermediate-dose as the caesarean rate was higher with high-dose (24.6% vs 7.9%, p = 0.011). Although the caesarean rate was higher in multiparous women with high-dose oxytocin, it was statistically not significant (5.7% v...
International journal of obstetric anesthesia, 2010
Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves ... more Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. We therefore studied the effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing caesarean section were included in a prospective, double blind, placebo-controlled trial. Patients were randomly assigned to receive spinal anaesthesia with 2 mL 0.5% hyperbaric bupivacaine and 25 microg fentanyl with either 0.1 mL of 0.9% sodium chloride (control group) or 0.1 mL of 50% magnesium sulphate (50 mg) (magnesium group). Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesia re...
Though a number of barrier methods and potent spermicides are available, most of these have nonox... more Though a number of barrier methods and potent spermicides are available, most of these have nonoxynol-9 (N-9) as the active ingredient which is observed to cause inflammation and genital ulceration on repeated use. The present study was undertaken to develop a safe spermicide with conjoint microbicidal properties. A polyherbal pessary was formulated with purified ingredients from neem (Azadirachta indica) leaves, Sapindus mukerossi (pericarp of fruit) and Mentha citrata oil. Spermicidal action on human sperm was tested by Sander-Cramer slide test in vitro and by post coital tests in vivo. Contraceptive action was tested in rabbits. The combination of the three herbal ingredients resulted in the potentiation of the spermicidal action by 8-folds. The post coital tests confirmed the spermicidal properties of the Praneem polyherbal pessary (PPP) in women with high cervical mucous score around mid estrus. It also prevented in most women the migration of sperm into the cervical mucous. In...
The present study evaluates the role of prophylactic intrapartum antibiotics in the prevention of... more The present study evaluates the role of prophylactic intrapartum antibiotics in the prevention of neonatal sepsis. Labour and delivery characteristics of 1478 women delivering at the Nehru Hospital, PGIMER, Chandigarh were recorded. Intrapartum antibiotics (ampicillin, with or without gentamycin) were given to 69 per cent women. The neonatal sepsis rate was 1.56 per cent. This was not significantly lower in the women who received intrapartum antibiotics (1.47 vs 1.75%). Though there was a lowering of neonatal sepsis rate with intrapartum antibiotic administration when the duration of labour was more than 12 h (1.67 vs 3.09%), duration of ruptured membranes was more than 6 h (1.93 vs 3.81%) and number of pelvic examination was 3 or more (1.63 vs 4.54%), it was not statistically significant. It was concluded that intrapartum antibiotics as per the existing protocol did not prevent neonatal sepsis.
Birth weight charts of uncomplicated singleton pregnancies (n=3293) were prepared from subjects w... more Birth weight charts of uncomplicated singleton pregnancies (n=3293) were prepared from subjects who delivered between 30 and 42 weeks of gestation. Multiple regression analysis of the data revealed significant effect of maternal age, parity, height, weight and religion upon birth weight. Maternal blood pressure systolic ≥160 mm of Hg and diastolic ≥110 mm of Hg (severe PIH) were associated with
methods that are less dependent on patient positioning, which is one potential limitation of ster... more methods that are less dependent on patient positioning, which is one potential limitation of sternomental distance measurement. For instance, it has been shown that sternomental distance may change depending on when the measurement is taken; that is, before (sitting, conscious) or after (supine, unconscious) induction of general anesthesia [6]. Regardless of the assessment method used, predicting a difficult airway is highly subjective. Indeed, various factors, including patient anatomy and co-morbidities, technical skill and experience of the assessor, and medications administered (e.g. neuromuscular blocking drugs), influence the degree to which a difficult airway can be predicted with accuracy. In any case, these methods are merely used to prepare oneself for the possibility of a difficult airway – the true test comes at the time of intubation. As has been stated before with respect to physical examination methods, no screening test is 100% sensitive and 100% specific [5]. Similarly, we anticipate that ultrasonography will not predict difficult intubation all the time. Thus, I believe that ultrasound and physical methods should be used in combination to obtain the best idea of how difficult intubation will be for a given case.
Cancer imaging : the official publication of the International Cancer Imaging Society, Jan 18, 2011
Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable m... more Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable malignant potential known to occur anywhere in the body. IMFT involving the omentum is a very rare entity with less than 15 cases reported so far. We report a case of omental IMFT in a 15-year-old girl who presented with multiple peritoneal masses on imaging and the diagnosis was confirmed on histopathology. In addition to its uncommon location, its presentation as multiple masses is extremely uncommon. This uncommon presentation as multifocal masses needs to be distinguished from other causes of peritoneal carcinomatosis.
Hydatidiform mole (HM) is a human pregnancy with excessive trophoblastic proliferation and abnorm... more Hydatidiform mole (HM) is a human pregnancy with excessive trophoblastic proliferation and abnormal embryonic development that may be sporadic or recurrent. In the sporadic form, the HM phenotype is driven by an abnormal ratio of paternal to maternal genomes, whereas in the recurrent form, the HM phenotype is caused by maternal-recessive mutations, mostly in NLRP7, despite the diploid biparental origin of the HM tissues. In this study, we characterised the expression of the imprinted, maternally expressed gene, CDKN1C (p57(KIP2)), the genotype, and the histopathology of 36 products of conception (POC) from patients with two defective alleles in NLRP7 and looked for potential correlations between the nature of the mutations in the patients and the various HM features. We found that all the 36 POCs are diploid biparental and have the same parental contribution to their genomes. However, some of them expressed variable levels of p57(KIP2) and this expression was strongly associated wit...
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